South Eastern European Journal of Public Health

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Authors: Peter Schröder-Bäck, Els Maeckelberghe, Miguel Ángel Royo Bordonada

Sometimes researchers and practitioners of public health are confronted with situations where it is not self-evident which option for action is the better choice. A decision about implementing a particular public health intervention can be difficult because there is a lack of scientific evidence that would speak clearly for or against its effectiveness. Moreover, a decision can be difficult because of moral values that are at stake. Indeed, taking a decision might sometimes feel like replacing one evil with another; or at least accepting some restrictions of liberty of individuals in the trade-off for another good, e.g. the health of others. Examples of difficult choices can be to implementing quarantines and isolations (like those being currently in place in relation to the Ebola outbreak in West-Africa), obligatory immunizations, prohibitions of risky behaviour or (re-)distributing resources.

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Authors: Toni Yonkov Vekov

Aim: The aim of this study was to assess the economic performance of the application of the policy for negotiating discounts on drug products and agreements on the controlled access of patients in Bulgaria. Methods: The methodology involves comparison of the amounts of public spending on medicines in two periods – during the course of the analyzed drug policies (January 2007 – June 2009), and the period in which negotiations on the price of medicines and programs for the controlled access of the patients was discontinued (July 2009 – December 2012). Results: In Bulgaria, the government did not apply methods for controlling public expenditure on medicines bargaining price concessions from manufacturers and implementing agreements on controlled access of patients after June 2009. This led to an annual increase in the expenditures on drug products for home treatment (on average, 17% for the period 2009-2012). Conclusion: This trend in Bulgaria will continue in the future since expenditure control only through price control by means of a reference system and the positive list of medicines is ineffective. There is a need for implementation of combined drug policies in Bulgaria in the form of negotiations on rebates with manufacturers and agreements on controlled access of patients and reference pricing.

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Authors: Katarzyna Czabanowska, Ulrich Laaser, Louise Stjernberg

The aim of this short report is to stimulate a discussion on the state of a public health profession in Europe and actions which need to be taken to authorise public health professionals based on their competencies. While regulated professions such as medical doctors, nurses, lawyers, and architects can enjoy the benefits of the 2005/36/EC Directive amended by 2013/55/EU Directive on the recognition of professional qualifications, public health professionals are left out from these influential (elite) professions. Firstly, we use the profession traits theory as a framework in arguing whether public health can be a legitimate profession in itself; secondly, we explain who public health professionals are and what usually is required for shaping the public health profession; and thirdly, we attempt to sketch the road to the authorisation or licensing of public health professionals. Finally, we propose some recommendations. Keywords: profession, professionalization, public health, recognition of professional qualifications.

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Authors: Fitim Skeraj, Katarzyna Czabanowska, Gazmend Bojaj, Genc Burazeri

Aim: Family physicians and general practitioners are currently facing increasing demands to meet patients’ expectations and rapid technological and scientific developments. The aim of this study was to determine the self-perceived level of competencies of primary health care physicians in Kosovo, a post-war country in the Western Balkans. Methods: A cross-sectional study was conducted in Kosovo in 2013 including a representative sample of 597 primary health care physicians (295 men and 302 women; mean age: 46.0±9.4 years; response rate: 90%). A structured self-administered questionnaire was used in order to determine physicians’ competencies regarding different domains of the quality of health care. The questionnaire included 37 items organized into six subscales/domains. Answers for each item of the tool ranged from 1 (“novice” physicians) to 5 (“expert” physicians). An overall summary score (range: 37-185) and a subscale summary score for each domain were calculated for each participant. General linear model was used to assess the association of physicians’ self-perceived level of competencies with covariates. Results: The internal consistency of the whole scale (37 items) was Cronbach’s alpha=0.98. Mean summary score of the 37-item instrument and subscale summary scores were all higher in men than in women. In multivariable-adjusted models, mean level of self-perceived competencies was higher among older physicians, in men, those with >10 years of working experience, physicians serving >2500 people, specialized physicians and those involved in training activities. Conclusion: Our study provides useful evidence on the self-assessed level of competencies of primary health care physicians in post-war Kosovo. Future studies in Kosovo and other transitional settings should identify the main determinants of possible gaps in self-perceived levels of physicians’ competencies vis-à-vis the level of physicians’ competencies from patients’ perspective.

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Authors: Jerneja Farkas, Mitja Lainscak, Andreja Kukec, Mitja Kosnik

Aim: Behavioural risk factors have a significant impact on health. We aimed to assess health-related behaviour, health status, and use of healthcare services among managers of Slovenian hospitals and institutes of public health. Methods: This was a cross-sectional study which included management (directors, scientific directors, directors’ deputies) of Slovenian hospitals and institutes of public health (63 respondents; 57% women; overall mean age: 51±7 years; response rate: 74%). Data were obtained using an anonymous self-administered questionnaire. Results: About 35% of respondents were directors. More than half of the respondents were overweight or obese (52%), the majority were not sufficiently physically active (59%) and overloaded with stress (87%). Hypercholesterolemia (36%), spinal disease (17%), and arterial hypertension (16%) were most common chronic diseases. Whilst only few participants visited their general practitioner due their health complaints, blood pressure (76%), cholesterol (51%), and glucose (54%) were measured within last year in most of the respondents. Conclusion: Our findings point to a high prevalence of overweight and obesity as well as workplace-related stress among Slovenian public health managers. Therefore, effective preventive strategies should be focused on stress management along with promotion of healthy behavioural patterns.

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Authors: Vesna Bjegovic-Mikanovic, Katarzyna Czabanowska, Antoine Flahault, Robert Otok, Stephen M. Shortell, Wendy Wisbaum, Ulrich Laaser

With the growth and complexity of current challenges such as globalization, health threats, and ageing society, financial constraints, and social and health inequalities, a multidisciplinary public health workforce is needed, supported by new skills and expertise. It has been demonstrated that public health education needs to include a wider range of health related professionals including: managers, health promotion specialists, health economists, lawyers and pharmacists. In the future, public health professionals will increasingly require enhanced communication and leadership skills, as well as a broad, interdisciplinary focus, if they are to truly impact upon the health of the population and compete successfully in today‘s job market. New developments comprise flexible academic programmes, lifelong learning, employability, and accreditation. In Europe‘s current climate of extreme funding constraints, the need for upgrading public health training and education is more important than ever. The broad supportive environment and context for change are in place. By focusing on assessment and evaluation of the current context, coordination and joint efforts to promote competency-based education, and support and growth of new developments, a stronger, more versatile and much needed workforce will be developed. Keywords: public health competences, public health education, public health workforce.